Thread by @CTransTalks

I promised you a parting gift - so here it is.

Ive been seriously data gathering around adult GICs across the UK for the last year, all obtained under FOI.

I have 5 years of comparative data, pre covid, 18/19 to 22/23.

Link at end of thread.

Buckle up.

1/?

In it you will find data around referrals, waiting lists, staffing, budget, and lots of other stuff.

Ive focussed on GICs as at this point the pilot schemes were not tendered as live services.

This is for the whole of the UK.

Lets dive in

2/?

Referrals :

Have effectively been flatlined for the last 5 years, with the main increase due to the new Welsh gender service

Referrals increased by about 14% in 5 years, but in numbers this is 120 per month, nationally.

Wales accounted for an average of 71 of this 120.

3/?

Waiting Lists:

Waiting Lists however have increased hugely, by 144% in the last 5 years, adding almost 21,000 people to a GIC waiting list, which sat at around 35,000 people as of 31 March 2023.

Only Notts / EoE GIC shows a significant decrease in waiting lists.

4/?

Referrals Vs Waiting Lists :

The picture becomes more stark when you compare the two.

Nationally, referrals have increased year on year by an average 4.5%, while waiting lists have increased by over 25% as a year on year average.

6/?

Heres the breakdown by country.

As we can see, Wales is basically static, all others have increased hugely.

7/?

Initial Assessments (IAs) :

Across the UK, the number of initial assessments being offered by clinics has increased by 18%, or only 65 per month.

Referrals are double that figure.

Only Wales has increased the number of initial assessments, every other country has declined

8/?

Its even worse when you look at individual clinics.

Almost every clinic are offering less IAs than they were compared to 5 years ago.

Take special note of London GIC, we will come back to that in particular later.

9/?

Total Appointments (TAs) :

This basically mirrors IAs, but we also have to remember this includes IAs.

Overall, TAs have increased by only 10%, or 365pcm nationally.

10/?

What if we exclude IAs?

The national trend doesnt change much, but theres a clear difference at clinic level, where its clear some clinics have shifted focus from IAs.

One response to an FOI suggested that this was at the direct instruction of the UK Gov via the DHSC.

11/?

Treatment Duration :

Only some clinics in England were able to provide this data, because they discharge service users to fend for themselves. Others were not because service users are never discharged, so remain under GIC care due in part to transphobic GPs.

12/?

Heres the graphs.

Overall, treatment durations increased by 71%, or 611 days.

Treatment Duration was 2.3 years in 18/19. By 22/23 it is over 4 years.

Only Notts / EoE GIC reduced treatment duration.

13/?

2nd Appt Duration :

Again, not all clinics held this data, but again its clear. there has been a substantial induced delay between IAs and 2nd Appts, which has increased by 81%, or 144 days from about 6 months to 11 months over the last 5 years.

14/?

Budgets :

Lets talk money.

Overall, budgets have increased nationally by 133%, or an average of 25% year on year, over the last 5 years.

Thats around £12.3 million, to over £21M.

Most of this has occurred in England, remembering we are *just* looking at GIC budgets.

15?/

Wheres the money going?

Well, its not on admin staff, which explains why GIC admin in notoriously crap.

And while all clinics have invested in clinical staff, some have done so more than others.

16/?

How was the money distributed?

Again, note the London GIC, which got a staggering £2.2M extra.

The London GIC budget (£6.7M in 22/23) accounts for about 40% of the entire GIC budget of England, but is one of the worst performing services.

17/?

Clinical Staff :

Heres where it starts to get *really* interesting.

Nationally, clinical staffing increased by 81% over the last 5 years, by an extra 75 people (full time equivalent).

18/?

So why are they delivering so few appointments?

Because most GICs are not investing in staff capable of delivering diagnostic assessments.

London GIC have only increased diagnostic capacity by 0.2 FTE (one fifth of a person) in 5 years, from 9.8 to 10 diagnostic staff.

19/?

Clinician Workload :

Lets look at workload by diagnostic clinician. How many initial assessments do they do per month?

Not very many, and *significantly* less than they did 5 years ago, almost across the board.

Most clinicians are not even doing 1 IA a day.

20/?

What about all appointments?

basically the same.

A serious question has to be asked of most GICs in 'What the hell are staff doing all day, playing Minesweeper?'

Because they sure as hell arent working, and Im sure theyll have tons of excuses.

21/?

So, what have we learned from this data?

The NHS has this data available, but has never bothered to collect it, let alone analyse it, despite knowing gender services have been in crisis for a least 8 years.

Nor have LGBT & Trans Orgs.

If I can do it, why havent they?

22/?

The data exposes every lie GICs tell about 'unprecedented rises in referrals', 'huge volumes of patients', 'no budget' and 'no staff' to excuse growing waiting lists.

In my option theres probably a number of factors at play, with low rates of clinician processing at No 1

23/?

What causes that? your guess is as good as mine, but based on both experience and talking to others, Id put most of my money on clinicians being both lazy and punch drunk on power, coupled with a service spec and diagnostic process that is over complex.

24/?

But what is clear is that

1) Clinicians simply arent doing their jobs.
2) GICs are catastrophically failing as a service model
3) Both the NHS and Gov are lying about 1 & 2.

The Welsh model seems to offer a way forwards, but even that appears to be stalling.

25/?

Anyway - thats not the end of it.

My real gift to you all is the data, available here :



Im also waiting on data for the last year to come in, and Ill make that available when its all come in.

26/ Enddocs.google.com/spreadsheets/d…